Baby death caused by wrongful administration of misoprostol in viable pregnancy | Baby Loss Awareness Week

For Every Birth. For Every Baby. For Every Family.

Fletchers solicitors were approached by Ms X, who suffered a late miscarriage of her pregnancy. This case study focuses on circumstances which highlight that medical paternalism is still practised and hinders autonomy when making decisions about care.

This case highlights the fact that ‘medical paternalism’ (a set of attitudes and practices in medicine in which a physician determines that a patient’s wishes or choices should not be honoured) is still sometimes practised and hinders patient autonomy when making decisions about their medical care.

After successfully settling the case, which was conducted by Susan Prior and Victoria Plesca, our client said:

“Thank you so much, I really appreciate all the work you have done. [Please include my case] on your website, especially if it helps other parents who experience the same events. I remember at the time I was searching for so many hours… trying to find similar cases.”

Background

After experiencing some mild bleeding during the first trimester of her second pregnancy, our client decided to attend the Emergency Department at Northampton General Hospital NHS Trust. She was reviewed by the Senior House Officer (“SHO” with a maximum two years’ experience in Obstetrics & Gynaecology) at 23:45. Based on a speculum examination only, a diagnosis of “inevitable miscarriage” was made and the decision was to admit Ms X and administer misoprostol.

Misoprostol is a drug (technically called an abortifacient) which stimulates uterine contractions and is also associated with effects that halt the pregnancy. It has the side effect of possibly causing birth defects if administered in healthy pregnancies. This decision of the SHO was discussed with the registrar, who concurred with the plan without examining our client or arranging an ultrasound examination.

Ultrasound could have revealed that pregnancy was viable

Despite her request for an ultrasound examination to confirm whether there was a heartbeat, Ms X was told that it was too late in the night for a scan. Later during the night, Ms X requested to be re-examined, but her request was again refused with the argument that nothing would have changed since the last examination. Misoprostol was then administered at 03:00 hours.

At 10:10 hours, Ms X finally underwent an ultrasound which detected a heartbeat and evidence of a viable intrauterine pregnancy of around eight weeks gestation. The consultant obstetrician and gynaecologist examined Ms X and “explained findings of viable intrauterine pregnancy but” that he “could not predict the effect of the misoprostol.” The consultant did not apologise for the error. Naturally, Ms X was relieved but concerned.

At 17 weeks gestation, Ms X started to bleed heavily, and so she arranged a private scan which confirmed absence of a fetal heartbeat. She was admitted to hospital where a further scan confirmed the intra uterine death of the baby. The post-mortem examination later showed that the baby was otherwise healthy and had been developing well.

Oral misoprostol was prescribed again to assist with emptying the uterus and delivery of the baby. The mother requested a scan to ensure that no products of conceptions were retained. In response, she was reassured and told that the scan was unnecessary.

Unfortunately, on the day of her baby’s funeral, she experienced further heavy bleeding and had to attend the hospital where an examination and a scan confirmed that there were, in fact, retained products of conception. Ms X had to undergo a surgical evacuation.

The claim

Our experts had investigated the case, a detailed letter of claim was prepared, in accordance with the pre-action protocol for the resolution of clinical negligence disputes, setting out how the Trust had breached their duty of care and what steps they should have taken in order to have avoided this sequence of events.

In their letter of response, the Trust admitted liability for all the allegations set out in the letter of claim and made an offer to compensate our client for her pain, loss, and suffering, followed by a letter of apology. The Trust accepted that our client should not have been prescribed misoprostol, without the appropriate steps being taken to ensure the correct diagnosis, and that it would ensure the quality of its service improved.

Susan Prior, a medical negligence partner at Fletchers office in Reading, says:

“Patient autonomy is a fundamental principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, appears to be a basic right but sometimes this can be forgotten. It would have been appropriate, in this case, to delay administration of the misoprostol until a confirmation scan could have performed.”

Baby Loss Awareness

Victoria spoke about her experience in handling baby loss claims, expressing her own feelings on the case, why it is important to support clients who have suffered baby loss as a result of medical negligence and the experience of handling such sensitive and emotional cases:

Unfortunately, many birth-related cases continue to reveal how frequently mothers’ voices are neglected. In this particular claim, a simple yet crucial request from the mother—to have an ultrasound scan before confirming a miscarriage diagnosis and administering a drug known to be harmful to the baby—was ignored. Had her concerns been acknowledged, the outcome could have been significantly different.

As the representing solicitor, you have the responsibility and privilege to ensure the clients’ voice is heard and you quickly learn that such incidents have significant impact on their lives. Handling cases of this nature requires a profound level of empathy and understanding. The psychological trauma experienced by parents is immeasurable and must be approached with great sensitivity. This is especially important during the evidence-gathering process, where clients are asked to recount events in detail, effectively reliving their trauma in order to establish the facts.

While this claim was emotionally challenging to pursue, it was deeply rewarding. It is easy to fall into the misconception that claimants in clinical negligence cases are primarily seeking financial compensation. In reality, this client’s foremost request was for an apology from the Trust and a commitment to review clinical guidelines to help prevent similar incidents from happening to others. Although a financial settlement was reached, the true resolution came from acknowledging her experience and advocating for systemic change.